Abstract
Background: Liver injury is common and also can be fatal, particularly in severe or critical patients with coronavirus disease 2019 (COVID-19).
Aim: To conduct an in-depth investigation into the risk factors for liver injury and into the effective measures to prevent subsequent mortality risk.
Methods: A retrospective cohort study was performed on 440 consecutive patients with relatively severe COVID-19 between January 28 and March 9, 2020 at Tongji Hospital, Wuhan, China. Data on clinical features, laboratory parameters, medications, and prognosis were collected.
Results: COVID-19-associated liver injury more frequently occurred in patients aged ≥ 65 years, female patients, or those with other comorbidities, decreased lymphocyte count, or elevated D-dimer or serum ferritin ( P < 0.05). The disease severity of COVID-19 was an independent risk factor for liver injury (severe patients: Odds ratio [OR] = 2.86, 95% confidence interval [CI]: 1.78-4.59; critical patients: OR = 13.44, 95%CI: 7.21-25.97). The elevated levels of on-admission aspartate aminotransferase and total bilirubin indicated an increased mortality risk ( P < 0.001). Using intravenous nutrition or antibiotics increased the risk of COVID-19-associated liver injury. Hepatoprotective drugs tended to be of assistance to treat the liver injury and improve the prognosis of patients with COVID-19-associated liver injury.
Conclusion: More intensive monitoring of aspartate aminotransferase or total bilirubin is recommended for COVID-19 patients, especially patients aged ≥ 65 years, female patients, or those with other comorbidities. Drug hepatotoxicity of antibiotics and intravenous nutrition should be alert for COVID-19 patients.
Keywords: Alanine aminotransferase; COVID-19; Drugs; Liver injury; Prognosis; Risk factors.
【저자키워드】 COVID-19, Risk factors, Prognosis, drugs, Liver injury, alanine aminotransferase, 【초록키워드】 coronavirus disease, severe COVID-19, disease severity, Comorbidities, risk, D-dimer, Antibiotics, drug, medications, risk factor, Clinical features, Lymphocyte count, Patient, Factors, Aspartate aminotransferase, Laboratory parameters, Intensive, Critical, COVID-19 patients, mortality risk, Injury, intravenous, retrospective cohort study, Serum ferritin, total bilirubin, 95% confidence interval, measure, Female patients, increased mortality, treat, independent risk factor, Tongji Hospital, Prevent, effective, Wuhan, China, IMPROVE, collected, occurred, indicated, subsequent, elevated, was performed, prognosis of patient, consecutive patient, increased the risk, 【제목키워드】 risk, China, retrospective cohort study, increased mortality, Progressive,